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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage

Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage. Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Michael N. Diringer • Thomas P. Bleck • J. Claude Hemphill III • David Menon • Lori Shutter •

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Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage

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  1. Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference Michael N. Diringer • Thomas P. Bleck • J. Claude Hemphill III • David Menon • Lori Shutter • Paul Vespa • Nicolas Bruder • E. Sander Connolly Jr. • Giuseppe Citerio • Daryl Gress • Daniel Ha¨nggi • Brian L. Hoh • Giuseppe Lanzino • Peter Le Roux • Alejandro Rabinstein • Erich Schmutzhard • Nino Stocchetti • Jose I. Suarez • Miriam Treggiari • Ming-Yuan Tseng • Mervyn D. I. Vergouwen • Stefan Wolf • Gregory Zipfel Neurocrit Care (2011) 15:211–240

  2. Purpose & Process • The purpose of the consensus conference was to develop recommendations for the critical care management of patients following acute aneurysmal SAH • Experts from Europe and North America from the fields of neurosurgery, neurocritical care, neurology, interventional neuroradiology, and neuroanesthesiology were recruited based on their expertise related to each topic

  3. Methods The GRADE System: • The quality of evidence was graded as • High = Further research is very unlikely to change confidence in the estimate of effect • Moderate= Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate • Low = Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate. • Very low = Any estimate of effect is very uncertain • Recommendations were classified as strong or weak • According to the balance among benefits, risks, burden, and cost, and according to the quality of evidence

  4. Medical Measures toPrevent Rebleeding

  5. Seizures and ProphylacticAnticonvulsant Use

  6. Cardiopulmonary Complications

  7. Monitoring IntravascularVolume Status

  8. Managing IntravascularVolume Status

  9. Glucose Management

  10. Management of Pyrexia

  11. Deep Venous Thrombosis Prophylaxis

  12. Magnesium & Statins

  13. Definitions: Delayed Neurological Deterioration, Delayed Cerebral Ischemia and Vasospasm

  14. Monitoring for DCI andTriggers for Intervention

  15. a) Monitoring for DCI

  16. b) and Triggers for Intervention

  17. Hemodynamic Management ofDCI Blood Pressure

  18. Hemodynamic Management of DCIIntravascular Volume and Inotropy

  19. Hemodynamic Management of DCIHemodilution and Unsecured Aneurysms

  20. Endovascular Management of DCI

  21. Anemia and Transfusion

  22. Endocrine Function &Management of Hyponatremia

  23. High Volume Centers

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